Provider Demographics
NPI:1255660551
Name:SKELTON, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SKELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 HILLCROFT ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-3190
Mailing Address - Country:US
Mailing Address - Phone:713-981-4488
Mailing Address - Fax:713-271-1970
Practice Address - Street 1:6420 HILLCROFT ST
Practice Address - Street 2:SUITE 115
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-3190
Practice Address - Country:US
Practice Address - Phone:713-981-4488
Practice Address - Fax:713-271-1970
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist